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December 2005
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February 2006

Ovarian Cancer Test Elusive

Usa_today

USA Today ran a story on ovarian cancer testing that discusses the challenges of detecting ovarian cancer.  Nearly three out of four women are diagnosed with ovarian cancer after it has spread beyond the ovaries, making it the fourth-leading cancer killer among women.  While no testing can lead to "false positives", early detection remains key in treating ovarian cancer.

The article also has a quick summary of the pros and cons of screening methods including CA-125, sonograms and the OvaCheck blood test.   


The Long Run

I was able to get hold of my mom this morning as I drove over to Campbell for my long run.  I could run right from my doorstep, but I've got into the habit of going to Campbell and running along the Los Gatos Creek Trail, which is a long and scenic bike path.  Distance running can be a pretty solitary experience at the best of times, and at least along the bike trail there are always other runners, not to mention a few water fountains and bathrooms. 

More importantly, my mother was in excellent spirits.  Going over to the golf club and watching some of the match was a very positive experience.

"I was on a real high," she tells me.  "It was lady's day at the club so I got to see a lot of my friends.  It was really good."

We talked a bit about her medications.  She's switched off of Marinol, Oxy-Contin and Phenerol and the new drugs seem to be working fine.  She's a bit less distracted and while her appetite is not huge, she's eating regularly.  This is key to her well-being.

"The worst is when you're throwing up," she says.  "You lose all the progress and then it takes a couple of days to come back to full strength.  I still feel a little weak internally, sort of shakey.  I'm not shakey on the outside."

Her sister Carmel and her nephew Robert are visiting later today and she's enthusiastic about that. 

"How is work," she asks me.

"Work is good," I say. "I got a promotion."

"Did you get a raise?"  This is exactly the exchange I expect from my mother.  She has always been very goal oriented.  It's a good value I've learned form her; it has served me well.

"Yes," and I am at once proud and also embarassed.  Who knew that at 43 I'd still care what my mother thinks of my accomplishments.  But someone once told me that the only genuine congratulations are those from your mother, and I believe there is some truth to that.

We talk a bit more and she has more energy than she has had lately, which is very encouraging.  Eventually she loses her train-of-thought on something we say our goodbyes and our I-love-you's.

* * *

I do my long run along the creek trail and my spirits are higher.  The nice thing about running for me is I can focus on one thing and not think about work or my mother's situation.  I get into a groove where it's just about the next mile and the speed crowds out everything else.

I see a few other marathoners on the course.  I can always tell the marathoners from the casual runners.  Marathoners have a focused look in their eyes.  They may be tired and they may be moving fast or barely shuffling, but there is a concentration and determination.  It could be raining or a hundred degrees and they will still be out there, slack-jawed, eyes  straight ahead, completely absorbed and resolute.  For a marathoner, nothing gets in the way of the weekend long run.  No matter what pain or suffering there is on the long run, marathoners know that it is better to take their lumps during training because there will be that much less pain on race day.

Running along the Los Gatos Creek Trail sometimes feels like a secret society.  I've been running here often enough that I start to recognize some of the regulars and I will occasionally nod or smile at others to acknowledge the shared experience of it all. 

Long runs are typically run at a slow pace, slower than your goal pace for the marathon.  It's hard for me to run as slow as I should and my legs start to tire after about 12 miles.  I put on my iPod and let some classic rock and 80's music from U2, The Clash, and others keep me company. 

At mile 14, I noticed I've picked up my speed.  My last mile was at an 8:00 pace, which is a bit fast, but I'm getting bored, so I decide to keep the faster pace for another 2 miles.  It's good to push yourself for the last 2 or 3 miles on a long run.  The last mile is miserable in the way that the last mile of every long run is miserable.  I keep looking at my watch to see how much further I have to go, impatient for it to be over.  But I finish my 17 miles and I know no matter what else happens, I accomplished something good.


A Good Day

I spoke to my sister Karen tonight while driving home from work.  I haven't been able to get hold of my parents for a couple of days, so I figured she could fill me in.  "Yesterday was a good day for mom," she said.  "She went to the golf club with her friend Zil." 

This is  a significant improvement.  My mom has stayed around the house since Christmas, not venturing further than the backyard.  She hasn't been moping around and she's had many visitors, but still, she hasn't strayed far.   So it was good for her to get some fresh air and see friends.  She didn't feel well enough to hit any golf balls, but maybe next time.

I told Karen that my wife and I will be back in Florida to visit my parents next week.  It's only a few days, but its still good.  She said she's glad that Shawn, Mike, Tim and I have all been able to visit since Christmas.  She thought maybe no one would able to. 

We talked a bit about Christmas.  I told her I hadn't realized it at the time but it really was the last opportunity we had to get everyone together for Christmas.  I don't even remember the last time we had the whole family together.  We have five kids in our family and as people got married and had kids its become harder to do.  Usually there's a few of us who get together at Christmas, but its been more than 10 years since everyone got together. When we were in our twenties, we used to joke about my mom and dad giving us a bit of a guilt trip saying they didn't have that many Christmas's left.  And now it had come true.

"We blew it," I said.  "It was great that you guys were there, and Tim and his family, but we didn't get everyone. " 

"I joked with mom about it," she said. "She wanted to know if I told everyone it would be her last Christmas.  She was able to laugh about it."   We didn't know it would be her last Christmas, but maybe mom knew.  It wouldn't have been her way to let people know.  She wouldn't want anyone to feel bad about it. 

"You know it's mom and dad's fiftieth anniversary this September," she said.  "I thought we would be able to get everyone together and have dinner with mom and dad at their golf club."

I didn't understand at first and I didn't know what to say.  "But, mom won't be there," I stammered.  She isn't going to make it past Easter, let alone September. 

"Maybe we could get everyone together before then," she said. "I'll be in Florida for a few weeks in March.  I think mom and dad would really appreciate it."

It's an idea.  Why not?  I don't want to regret that we missed the last Christmas. 

* * *

I'm listening to the Sex Pistols really loud while I write this and by the time I finish, I fall apart crying. 


Painkillers Reduce Risk of Ovarian Cancer

Ibuprofen 

A recent study from Duke University Medical Center indicates that use of common painkillers such as Ibuprofen and Aspirin (known technically as NSAIDs or non-steroidal anti-inflammatory drugs.)  NSAID users were 28% less likely to develop ovarian cancer than non-users. 

Further research is required in order to confirm the link between NDAIDs and cancer and clarify various issues.  


Frustrated

I talked to my father and brother Tim this morning.  It seems that yesterday the Hospice has switched dispensing pharmacies and they have decided that they cannot fill my mother's prescription for her pain patches (phenerol?) or the synthetic marijuana, Marinol.   She has a couple of days supply but is clearly worried about running.

Not only that, but my mother's been throwing up and unable to keep any food down.  That's one of the arguments in favor of medical marijuana as compared to Marinol is that its easier for people to ingest it when they are having trouble keeping food down.

My mother is upset about all this  She's made her peace with dying and has no fears other than the pain.  Now they want to take away the pain medications.  Can they do this?  Where is the compassion?


Kentucky Ovarian Cancer Screening

Uky_wildcats 

The University of Kentucky has announced results from their ovarian cancer screening program.  To date more than 25,000 women have participated recieving more than 120,000 screenings.  The process takes 5 to 10 minutes and is completely painless. 

Ovarian cancer is often referred to as the "silent killer" since it is often not detected until it is in an advanced stage.  Early detection through screenings is a key initiative in reducing the mortality rate. 


Sister Jean

Nuns_beach  

Today was a good day for my mom.  She appears to have got back her energy and is doing well.  She had a visit from Sister Jean, a nun from their local small faith group.  She wanted some private time with her, so my father and my brother Tim left the house for a while.  She wants to get everything buttoned up regarding the funeral. 

Tim says she's decided on cremation, which is good.  I happen to think that's the best way to go, but the important issue is that she's had the discussion and now everyone knows what her last wishes are.  There won't be any ambiguity. 

My wife and I have booked flights to get to Orlando next week.  My mother's sister Carmel will be visiting on the weekend before and my sister will be arriving after we leave.  We'll be there for three full days, leaving a buffer on either side.  I wanted to make sure my parents have a couple of days on their own without visitors. 


The Process

Housemartins_2

My brother Tim is visiting my parents in Orlando.  He arrived on Thursday and I've spoken to him the last two days.  Today is Saturday, so I call him while I'm driving before going out for a long run.

Today he told me he's worried that my mother is entering into what he calls "the process" which I take to mean a stage of gradual ongoing deterioration.  She's becoming a bit less aware of her environment.  She is focused and lucid in conversation, but increasingly forgets what day or time it is.  She was confused thinking that my brother Michael was visiting, though he's been gone for two weeks.  I asked if he thought this was related to her medications, but he didn't think so; she had only taken one Marinol.   She's wobbly when she walks, easily losing her balance.  Tim is worried about leaving her at the house alone for any length of time, in case she should fall. 

Gradual deterioration is hard to notice.  When someone is aging rapidly we tend to make rationalizations for what's going on, perhaps missing the warning signs.  Mom was sick and throwing up, so it must be from something she ate.  She's weaker today than she was yesterday, but it's because she was sick.  Once her appetite comes back, she'll be ok.  She's confused, so maybe its the pain medications.  She's in good spirits, but it's because she's optimistic.

And while we all want to be positive and assume the best, we need to pay attention to the warning signs.  My mom is deterioriating and she is going to get weaker and sicker in the weeks and months ahead.  She will become more confused and perhaps more detached from what's going on.

I go out for my run and I do ok until I get 10 miles into it.  I'm listening to my iPod and I hear the song "Caravan of Love" by the HouseMartins.  It's sung acapella in the style of a gospel hymn.  I think it's a song my mother would like; the melody and lyrics are uplifting.  But then I have this image of the song playing and I can't help but hear it as a funeral dirge.  And I just lose it completely.  I am heaving and tears are coming down mixed with the sweat from my brow.  But I keep running and I think about how strong my mother is.  Soon enough the feeling of sadness passes and I regain my composure.  I continue running another 5 miles until the pain exhausts me. 


Running Tough

Zack_svm_small

I've decided to get back into running more seriously.  At the end of  October I ran the Silicon Valley Marathon and qualified for Boston with a time of 3:18 and change, a personal record or PR.  The bad news is I'm behind schedule in training for Boston in April.  I'm not aiming for a fast time (it's not like I'm going to win!) but I also don't want to hurt any more than I have to on race day.

So this morning I went out and ran intervals.  It was cold and dark when I got to the track in Los Gatos.  I ran intervals starting at 1200 meters (3 laps) descending by 200 meters each interval with 200 meters (half a lap) slow running (or in my case, crawling) in between.  It's hard work.  But it makes you tough. 

As I was running I was thinking about my mom.  Running intervals is hard work, but its easy compared to what my mom is going through.  That gave me strength. 


New Treatment for Ovarian Cancer

Nytimes_large_3

Several news services, including the New York Times, have published an article highlighting the results of a recent study on ovarian cancer from the New England Journal of Medicine showing that abdominal chemotherapy could help patients.  This is the third such study in a decade to show positive results with this treatment.  The National Cancer institute took the unusual step of formally announcing to doctors that they should offer this treatment to all women who met the criteria.  The abdominal treatment combined with traditional intravenous chemotherapy could add sixteen months or more to the lives of women with advanced chemotherapy.

But the abdominal treatment is not without its challenges.  The side-effects are more severe than traditional chemotherapy. The process is also more difficult to administer.  But as the New England Journal of Medicine points out, the intense therapy boosts survival rates.